attempting to increase the use of smoking cessation medications brendon baker ministry of health
TRANSCRIPT
Attempting to increase the use
of smoking cessation
medications
Brendon Baker
Ministry of Health
Most people try to quit without support
Cold Turkey!
Quitting without support
The majority of people who quit this way will relapse in the first week
Only 2.5%
abstinent at 1-year
Why do smokers quit without support?
People who smoke• Don’t believe they need treatment• Don’t know about treatments• Can’t access treatments (cost and
availability)• Don’t believe treatments work
Why do smokers quit without support?
Healthcare professionals• May lack knowledge / feel unsure about
tobacco dependence and smoking cessation
• May hold similar beliefs to those of smokers
• Don’t believe they can help• Lack resources (time, money) to
help as they might like
Subsidised Pharmacotherapy
Odds ratio (95% CI) NNT
NRT 1.77 (1.66 -1.88) 17
Bupropion 1.94 (1.72 – 2.19) 13
Nortriptyline 2.34 (1.61 – 3.41) 13
Varenicline 3.22 (2.43 – 4.27) 7
Cochrane Library of Systematic Reviews
• Nicotine replacement therapy• Bupropion (Zyban)• Nortriptyline• Varenicline (Champix) (since 1 November
2010 on ‘special authority’)
New Sole Supply NRT agreement in 2011
Pharmaceutical andformulation Strength Pack size Proposed priceand subsidyNicotine lozenge 1 mg 216 $19.94Nicotine lozenge 2 mg 216 $24.27Nicotine patch 7 mg 28 $18.13Nicotine patch 14 mg 28 $18.81Nicotine patch 21 mg 28 $19.14
• Unlike the currently listed smaller pack sizes, no rebate would apply to the larger pack sizes of nicotine lozenges and nicotine patches.
NRT monthly expenditureNRT Drug Cost
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
$1,400,000
$1,600,000
$1,800,000
Jul-
06
Au
g-0
6S
ep
-06
Oct
-06
No
v-0
6D
ec-
06
Jan
-07
Fe
b-0
7M
ar-
07
Ap
r-0
7M
ay-
07
Jun
-07
Jul-
07
Au
g-0
7S
ep
-07
Oct
-07
No
v-0
7D
ec-
07
Jan
-08
Fe
b-0
8M
ar-
08
Ap
r-0
8M
ay-
08
Jun
-08
Jul-
08
Au
g-0
8S
ep
-08
Oct
-08
No
v-0
8D
ec-
08
Jan
-09
Fe
b-0
9M
ar-
09
Ap
r-0
9M
ay-
09
Jun
-09
Jul-
09
Au
g-0
9S
ep
-09
Oct
-09
No
v-0
9D
ec-
09
Jan
-10
Fe
b-1
0M
ar-
10
Ap
r-1
0M
ay-
10
Jun
-10
Jul-
10
1st NY ad campaign & annual CPI adjustment
Quit Cards online
Prescribers giveout Quit Cards
On prescription
Excise tax
Prescribing of NRT
Prescriptions issued for 21 mg patches:
• September 09 – 814 (5012 Quit Cards)
• May 10 – 1802 (8031)• July 10 – 1847 (5379)
Prescribing of Zyban
Sep 09 – 2168 scripts
July 10 – 3935 scripts
Where to from here?
Māori Affairs Select Committee recommendations
• Tobacco companies should pay for meds
• NRT required to be sold everywhere tobacco is
• Allow Pharmacists to be Quit Card providers
Conclusions
There has been significant progress made
More can be done - still 650000 smokers
Potential growth areas:• Prescribers• Champix/Zyban/Nortripyline• Māori Affairs Select Committee
Recs